心脏手术相关急性肾损伤病理生理、诊断及风险评估研究进展

Research Progress of Pathophysiology,Diagnosis and Risk Assessment of Cardiac Surgery Associated Acute Kidney Injury

急性肾损伤(AKI)是心脏手术后常见的严重并发症,可导致患者术后死亡风险增加。若未及时、有效治疗,患者术后将出现肾功能不全,严重时出现慢性肾脏病,需要持续床旁血液透析治疗。心脏手术相关AKI(CSA-AKI)的发病机制复杂,涉及多种因素,目前存在多种相关病理生理学理论。除诊断标准外,生物标志物的探索和验证是CSA-AKI诊断领域的研究重点。常见的策略包括维持肾血流灌注、个体化血压目标、液体平衡的管理、有目标导向的氧气输送和避免肾毒性药物。未来深入研究CSA-AKI的病理生理、诊断及风险评估将有助于降低CSA-AKI相关死亡率,改善患者预后。

Acute kidney injury(AKI)is a common and serious complication after cardiac surgery,which can increase the risk of postoperative mortality in the patients.If not treated in a timely and effective manner,the patients may experience renal dysfunction after surgery,and in severe cases chronic kidney disease may occur,requiring continuous bedside hemodialysis treatment.The pathogenesis of cardiac surgery associated AKI(CSA-AKI)is complex,involving multiple factors,and there are currently multiple related pathological and physiological theories.In addition to diagnostic criteria,the exploration and validation of biomarkers is a research focus in the field of CSA-AKI diagnosis.Common strategies include maintaining renal blood flow perfusion,individualized blood pressure targets,management of fluid balance,goal oriented oxygen delivery,and avoiding nephrotoxic drugs.In the future,in-depth research on the pathophysiology,diagnosis,and risk assessment of CSA-AKI will help reduce CSA-AKI related mortality and improve patient prognosis.